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Related Concept Videos

Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant01:25

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant

In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
Renal Drug Excretion: Overview01:15

Renal Drug Excretion: Overview

As primary excretory organs, the kidneys maintain homeostasis by removing waste substances from the bloodstream. They comprise over a million units called nephrons, which serve as the kidney's functional units.
A nephron consists of two primary structures: the renal corpuscle and the renal tubule. The renal corpuscle contains the glomerulus, a network of capillaries where the first step of renal excretion, glomerular filtration, occurs. Blood pressure forces water, ions, and small molecules out...
Renal Drug Excretion: Tubular Reabsorption01:25

Renal Drug Excretion: Tubular Reabsorption

Tubular reabsorption, a process occurring post-glomerular filtration of drugs in the renal tubule, is a critical determinant of drug half-life. During the process of renal excretion, as the glomerular filtrate progresses to the distal convoluted tubule (DCT), drugs that are highly permeable, lipophilic, and nonionized undergo passive reabsorption from the tubular fluid into the surrounding peritubular capillaries. This reabsorption process restricts their elimination through the kidneys. This...
Renal Drug Excretion: Tubular Secretion01:28

Renal Drug Excretion: Tubular Secretion

Active tubular secretion is a robust, energy-demanding process that utilizes carrier systems to transport drugs into renal tubules. The active renal secretion systems include the organic anion transporter (OAT) for weak acids and the organic cation transporter (OCT) for weak bases. Structurally similar drugs can compete for the same transporter, potentially leading to drug accumulation and toxicity. However, this principle can be exploited therapeutically. One example is probenecid (Probalan),...

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Updated: Jun 15, 2026

A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically
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A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically

Published on: September 9, 2015

Recent changes in vancomycin use in renal failure.

Stefaan J Vandecasteele1, An S De Vriese

  • 1Division of Nephrology and Infectious Diseases, Department of Internal Medicine, AZ Sint-Jan Brugge-Oostende AV, 8000 Brugge, Belgium. Stefaan.Vandecasteele@azbrugge.be

Kidney International
|February 26, 2010
PubMed
Summary
This summary is machine-generated.

New guidelines recommend higher vancomycin doses for serious infections. However, achieving these levels, especially in kidney disease patients, increases nephrotoxicity risk, requiring careful monitoring.

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Nanomechanics of Drug-target Interactions and Antibacterial Resistance Detection
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Nanomechanics of Drug-target Interactions and Antibacterial Resistance Detection

Published on: October 25, 2013

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Last Updated: Jun 15, 2026

A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically
11:28

A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically

Published on: September 9, 2015

Nanomechanics of Drug-target Interactions and Antibacterial Resistance Detection
11:56

Nanomechanics of Drug-target Interactions and Antibacterial Resistance Detection

Published on: October 25, 2013

Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Nephrology

Background:

  • Vancomycin is crucial for treating Gram-positive infections.
  • Increasing vancomycin resistance in staphylococci necessitates higher doses.
  • New guidelines suggest higher target trough levels (15-20 microg/ml).

Purpose of the Study:

  • Evaluate achievement of new vancomycin targets in patients with chronic kidney disease or on dialysis.
  • Assess the risk of vancomycin-induced nephrotoxicity with higher doses and targets.
  • Identify patient populations at increased risk for nephrotoxicity.

Main Methods:

  • Review of current literature on vancomycin dosing and resistance.
  • Analysis of pharmacokinetic data for vancomycin in renal impairment.
  • Evaluation of clinical outcomes and adverse events associated with higher vancomycin exposure.

Main Results:

  • Higher vancomycin doses are proposed to reach target trough levels.
  • Achieving these targets in renal impairment remains challenging and under investigation.
  • Increased vancomycin doses and trough levels correlate with higher nephrotoxicity risk.

Conclusions:

  • Higher vancomycin doses increase nephrotoxicity risk, particularly with elevated trough levels and prolonged use.
  • Critically ill patients, those on concomitant nephrotoxic agents, and those with pre-existing renal dysfunction are most vulnerable.
  • Careful consideration and monitoring are essential when using higher vancomycin doses, especially in patients with kidney disease.